质子泵抑制剂在住院期间对患有肝性脑病和肝硬化但无活动性胃肠道出血患者死亡率的影响。
Effect of proton pump inhibitors in hospitalization on mortality of patients with hepatic encephalopathy and cirrhosis but no active gastrointestinal bleeding.
作者信息
Hung Tsung-Hsing, Lee Hsing-Feng, Tseng Chih-Wei, Tsai Chih-Chun, Tsai Chen-Chi
机构信息
Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
Department of Mathematics, Tamkang University, Tamsui, Taiwan.
出版信息
Clin Res Hepatol Gastroenterol. 2018 Sep;42(4):353-359. doi: 10.1016/j.clinre.2017.11.011. Epub 2018 Mar 16.
BACKGROUND
Hepatic encephalopathy (HE) is a neuropsychiatric complication of decompensated cirrhosis. Proton pump inhibitors (PPIs), used as potent acid suppressants, are associated with HE occurrence in cirrhotic patients. However, it is still unknown if PPIs contribute to mortality in cirrhotic patients with HE and no active gastrointestinal bleeding.
METHODS
We used the Taiwan National Health Insurance Database to identify 1004 cirrhotic patients with HE and no active gastric bleeding, who received oral PPIs between January 1, 2010 and December 31, 2013. On the basis of comorbid disorder data, we used propensity score matching at a 1:4 ratio to select 4016 cirrhotic patients with HE and no active gastric bleeding who did not receive PPIs as a comparison group. All patients were followed up for one year from the index time.
RESULTS
The overall 30-day, 90-day, and 1-year mortalities were 36.1%, 52.6%, and 70.1% in PPI group, and 27.5%, 41.7%, and 62.4% in non-PPI group. Using Cox regression model analysis with adjustment for age, gender, and other comorbid disorders, we obtained hazard ratios of 1.360 (95% CI: 1.208-1.532, P<0.001), 1.563 (95% CI: 1.314-1.859; P<0.001), and 1.187 (95% CI: 1.008-1.398; P=0.040) for, respectively, 30-day, 30-day to 90-day, and 90-day to 1-year mortality in patients taking PPIs.
CONCLUSION
PPIs increase short-term and long-term mortality of cirrhotic patients with HE and no active gastrointestinal bleeding.
背景
肝性脑病（HE）是失代偿期肝硬化的一种神经精神并发症。质子泵抑制剂（PPIs）作为强效抑酸剂，与肝硬化患者发生HE有关。然而，PPIs是否会导致无活动性胃肠道出血的肝硬化合并HE患者死亡仍不清楚。
方法
我们利用台湾国民健康保险数据库，确定了1004例患有HE且无活动性胃出血的肝硬化患者，这些患者在2010年1月1日至2013年12月31日期间接受了口服PPIs治疗。根据合并症数据，我们以1:4的比例使用倾向评分匹配法，选择了4016例患有HE且无活动性胃出血但未接受PPIs治疗的肝硬化患者作为对照组。所有患者从索引时间开始随访一年。
结果
PPI组的30天、90天和1年总死亡率分别为36.1%、52.6%和70.1%，非PPI组分别为27.5%、41.7%和62.4%。通过Cox回归模型分析，并对年龄、性别和其他合并症进行校正，我们得出服用PPIs患者的30天、30天至90天以及90天至1年死亡率的风险比分别为1.360（95%CI：1.208-1.532，P<0.001）、1.563（95%CI：1.314-1.859；P<0.001）和1.187（95%CI：1.008-1.398；P=0.040）。
结论
PPIs会增加无活动性胃肠道出血的肝硬化合并HE患者的短期和长期死亡率。
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